"Pure Rye Whisky 4 ounces
Pulverized Peruvian Bark 1 dram
Pulverized Rhubarb 1 ounce
Mix.
Put in bottles. Dose for adults:--One tablespoonful three times a day.
This is an excellent remedy."
[230 MOTHERS' REMEDIES]
2. Chills and Fever, Horse-radish for.--"Take fresh green horseradish
leaves, bruise and mash them to the consistency of a poultice and bind on
the bottom of the feet. This will tend to reduce the fever and is a
reliable remedy. I have often used this with great satisfaction."
3. Chills and Fever, Dogwood Known to be Good for.--"Make a decoction of
one ounce of dogwood root, boiled in one quart of water down to one pint;
strain, and give half wineglassful every two or three hours." This remedy
has been used by our grandmothers for many years, and is one to be
depended upon. The dogwood root can be purchased at any drug store.
Treatment.--For acute cases quinine in various doses. I usually prescribe
two grains every two hours until the ears ring, and then take only enough
to keep them in that condition.
It is well always to see that the bowels and liver are active before
taking quinine. The medicine acts better when the patient remains quiet in
bed. If the chill and fever comes on every day, the quinine should be
taken every hour between the paroxysms.
MALTA FEVER.--This occurs in the Mediterranean countries, India, China,
the Philippines and Porto Rico. The fever is irregular or marked by
intervals of "no fever" for two or more days with febrile relapses lasting
one to three weeks. Constipation, anemia (scarcity of blood), joint
symptoms and debility exist. Ordinary cases may last three months to two
years. Mortality two per cent.
Treatment.--Like that for typhoid. Change climate, if possible.
BERI-BERI.--Beri-beri is a disease rarely occurring in the United States.
It is usually found in the warmer climates and peculiar to certain regions
such as India, and Japan.
It is characterized by paralysis and fatal effusion, also neuritis, which
is an inflammation of the nerves. It seems to be undecided among the
medical profession as to whether the disease is infectious or not. Some
claim it is brought on by the eating of bad rice or certain raw fish.
Young men in those climates seem to be most susceptible to beri-beri.
Treatment.--There is very little known about this disease. Fortunately it
does not often occur here. It is necessary to keep up the strength by food
and tonics and relieve the pain.
ANTHRAX. (Charbon, Wool Sorters' Disease, Splenic Fever).--This is "an
acute infectious disease of animals, transmitted to man by inoculation
into the wounds, or by inhalation of, or swallowing the germs." Butchers,
tanners and shepherds are most liable to it. The exciting cause is the
bacillus anthracis (anthrax bacillus). The local skin condition is a
pustule containing the bacilli, which may also invade the general
circulation. If the germs are inhaled, there is broncho-pneumonia; if
swallowed, areas of inflammation and local death occur in the intestines.
The spleen and lymph nodes are enlarged.
[INFECTIOUS DISEASES 231]
Symptoms. 1. External anthrax, malignant pustule. This begins in a papule
(pimple) at the point of inoculation turning into a vesicle and then a
pustule, (blister-like pimple) surrounded by an inflammatory area (space)
with marked watery swelling. The nearby glands are enlarged and tender. At
first the temperature rapidly rises; later it may be below normal. The
fever symptoms may be severe. Recovery takes place slowly. Death occurs in
three to five days.
MALIGNANT ANTHRAX (swelling).--In this lesion is a pustule, with very
marked swelling. It most frequently occurs on the eyelid and face and the
swelling may terminate in fatal gangrene.
2. Internal anthrax.--(a) Internal anthrax is caused by the introduction
of the bacteria into the alimentary canal in infected meat, milk, etc. The
invasion is marked by a chill, followed by moderate fever, vomiting,
diarrhea, pain in the back and legs and restlessness. Sometimes
convulsions occur and hemorrhages into the skin from the mucous membranes.
The spleen is swollen. Prostration is extreme and it often ends in death.
(b) Charbon or Wool Sorter's disease occurs among those employed in
picking over wool or hair of infected animals--the germs being inhaled or
swallowed. The onset is sudden with a chill, then fever, pain in the back
and legs, and severe prostration. There may be difficulty of breathing and
signs of bronchitis, or vomiting and diarrhea. Death is a common
termination, sometimes within a day. Death rate is from five to twenty-six
per cent. Greatest when the swelling is near the head.
Treatment.--The wound or swelling should be cauterized and a solution of
carbolic acid or bichloride of mercury injected around it and applied to
its surface. Stimulants and feeding are important.
LOCKJAW. (Tetanus).--Tetanus or lockjaw, as it is commonly called, is an
infectious disease and is characterized by painful and violent
contractions of the voluntary muscles; it may be of the jaw alone or of a
considerable part of the body.
Causes.--The intelligence and mental faculties are not impaired. In most
cases it follows a wound or injury, although in others there seems to be
no exciting causes. Fourth of July celebrations furnish a great many of
our lockjaw cases. Ten to fifteen days usually elapse after the wound
before lockjaw really sets in.
[232 MOTHERS' REMEDIES]
Symptoms.--It comes on occasionally with a chill or chilly feelings;
usually by rigidity (stiffness) of the neck, jaw and face. On arising in
the morning there is sometimes a stiffness of the muscles at the back of
the head. It is not unusual on taking a slight cold to have a stiff neck
and often the patient's attention is not attracted by this symptom.
Sometimes this stiffness begins or soon extends to the muscles of the
lower jaw; the throat becomes dry and is painful and gradually the
stiffness increases to a continuous contraction, spasm, and extends to the
muscles of the trunk and extremities. The body becomes rigid in a straight
line or bent backward, forward or sidewise. This spasm occurs after any
slight irritation and is extremely painful. Temperature is usually low.
During the first spasms the patient may attempt to open his mouth as he
may naturally be suspicious of the trouble that is coming; he succeeds
with difficulty and even finds it hard to swallow; soon the jaws may be
firmly closed, and it is from this feature of the disease that it gained
the name of lockjaw. The contractions in some cases do not extend beyond
the neck and face muscles. During the contractions the face may be drawn
into frightful contortions. Food can be given only through such spaces as
may exist between the teeth, as often the patient cannot open his mouth
himself, nor can it be pried open by any force that would be allowable.
When the muscles of the trunk are affected the abdomen may be drawn
inward, become very hard and stiff, chest movements are affected, making
it difficult to breathe, sometimes almost to suffocation. Sometimes the
body becomes bent like a bow, as in some cases of spinal meningitis, so
that only the head and heels support the weight of the body. The body may
become so rigid that it can be lifted by a single limb as you would a
statue. It is fortunate that there are few cases, comparatively, of
lockjaw as the distorted face and general contractions of the body are
painful to witness.
Recovery.--The mortality in lockjaw cases runs about eight per cent.
Sometimes death is caused by exhaustion from the muscular exertions; the
patient is seldom able to sleep and sometimes wears out in a few days.
Sometimes suffocation brings a sudden end to his sufferings and usually
one or two days to ten or twelve days is the limit. Among the lower
classes where sanitary science is seldom observed, and even among the
better classes, lockjaw has been known to occur in infants. It usually
comes on, in ten to fifteen days after birth, and the child seldom lives
more than a few days, It is hard to account for such cases which may come
on suddenly from the slightest excitement such as sudden noises, etc.
MOTHERS' REMEDIES.--l. Lockjaw, Successful Remedy for.--"A very good and
successful remedy for this disease, is to apply a warm poultice of
flaxseed meal, saturated with laudanum and sugar of lead water, to the
jaws and neck."
2. Lockjaw, Smoke as a Cure for.--"Smoke the wound for twenty minutes in
the smoke of burnt woolen cloths. This is considered a never failing
remedy."
[INFECTIOUS DISEASES 233]
PHYSICIANS' TREATMENT.--If from a wound cut open and use antiseptics.
Isolate the patient and have absolute quiet. Antitoxin is used with
success in some cases of lockjaw, but this and other remedies or measures
must be handled by a physician, Opium is sometimes given and stimulants
such as brandy, whisky, etc. As it is a case of life or death in a very
short time, we cannot advise depending upon home treatment. A preventive
caution that must always be observed is the use of antiseptics and the
strictest care of all injuries and wounds that might result in lockjaw.
This is a disease where an ounce of prevention is worth a thousand pounds
of cure, because by the time the disease is recognized as lockjaw and has
really made an appearance, it may be too late for medical skill. While you
are waiting for the doctor you may apply cold cloths or even an ice bag to
the spine. If the spasms are severe let the patient inhale chloroform to
kill the pain and quiet him. In the meantime secure the best physician
within your reach, and follow his directions carefully, be calm and self-
possessed when in the presence of the patient, for you must remember that
he has full possession of his mental faculties and will notice every
evidence of fear or worry in the faces of those who are nursing him. This
will only add to his sufferings, affect his nervous system and undermine
his general vitality. Read carefully the nursing department in this book
and you will gain some valuable hints and knowledge regarding the sick
room.
GLANDERS.--This is an acute disease of the horse and occasionally of man.
It is called "glanders" when the affection appears in the nostrils, and is
called "farcy" when in the skin.
Causes.--The bacilli is usually introduced from infected horses through
the nose, mouth and cheek, mucous membranes or skin abrasions (rubbing off
of the skin). There are large or small lumps in the skin, mucous membrane
of the nose and mouth.
Symptoms. Acute Glanders.--1. Incubation lasts from three to four days.
There are signs of inflammation at the site of infection and general
symptoms. In two or three days, small lumps appear on the mucous membrane
of the nose, and ulcerate, with a discharge of mucus and pus. Sometimes
these nodules die locally, and their discharge is then foul. The glands
around the neck are enlarged. An eruption appears over the face and
joints. Inflammation of the lungs may occur. Death may take place in eight
to ten days.
2. Chronic Glanders.--This may last for months. It acts like chronic cold
with ulcer in the nose. Some recover.
3. Acute Farcy.--The local and general signs are those of an infection,
with necrosis (local death) at the site (in the skin) of inoculation;
nodules, (lumps) known as "farcy buds" form along the lymphatics (glands)
and form pus. There may be pus collections in the joints and muscles.
Death often occurs in one to five days.
Chronic Farcy.--Tumors in the skin of the extremities, containing pus. The
process is local, the inflammatory symptoms light, and the duration may be
months or years.
[234 MOTHERS' REMEDIES]
Treatment of Glanders.--This disease does not often occur in man; it is an
awful affliction. All infected horses must be killed, it is dangerous for
man to be around one. If seen early, the wound should be cut out or burned
out with caustics, and afterwards dressed like any wound. The "farcy buds"
should be opened early. There is very little hope in acute cases of
glanders. In chronic cases recovery is possible, but it will be after a
long tedious time. There must be proper nourishing food and tonic
medicines. Each case should be treated according to the indications. It is
safe to say the parts should be thoroughly cut or scraped out and then
treated with antiseptics and the general system built up, by tonics and
stimulating remedies, if needed. As stated before, acute glanders and
acute farcy are almost always fatal.
BIG-JAW OR LUMP-JAW. (Actinomycosis).--This is an infectious disease of
cattle, less frequently of man, and it is caused by what is called the
"ray fungus." This grows in the tissues and develops a mass with a
secondary chronic inflammation.
This disease is widespread among cattle, and also occurs in the pig. In
the ox it is called the "big jaw." The infection may be taken in with the
food, and it locates itself often in the mouth or surroundings. Oats,
barley, and rye may carry the germ to the animals. The fungus may be found
even in decayed teeth.
Alimentary Canal Type.--The jaw has been affected in man. One side of the
face is swollen or there may be a chronic enlargement of the jaw, which
may look like a sarcoma (tumor). The tongue also is sometimes affected and
shows small growths. It may also occur in the intestines and liver. There
is at first a tumor (lump), and this finally suppurates.
In the Lungs.--They also can be affected. It is chronic here and there is
cough, fever, wasting and an expectoration of mucus and pus, sometimes of
a very bad odor (fetid). It sometimes acts like miliary tuberculosis of
the lungs, and this is quite frequent in oxen. Other diseases of the lungs
and bronchial affections occur and abscesses and cavities are formed that
may be diagnosed during life.
Symptoms.--If in the jaw there may be toothache, difficulty of swallowing
and of opening the jaw. The adjacent muscles may be hardened (indurated).
A swelling appears at the angle of the jaw and this quickly passes into
suppuration; later it opens first outside, then inside--into the mouth and
discharges pus containing little yellow masses. It will extend down even
into the bowels unless it is properly treated. Then there will be stomach
disturbances and diarrhea. It may ulcerate through the bowels and cause
peritonitis. The liver, spleen and ovaries may also become affected.
The Skin.--There may be chronic suppurating ulcers of the skin and the
"ray fungus" can be found in them.
Diagnosis.--The "ray fungus" can be found. There is a wooden hardness of
the tissues beyond the borders of the ulcers; there are the little yellow
granules in the pus. The course is chronic. Mild cases recover in six to
nine months or earlier, the mouth form being the most favorable.
[INFECTIOUS DISEASES 235]
Treatment.--Surgical. Remove the parts involved. Internally, iodide of
potash in large doses is recommended. The food should be plenty and
nourishing. In this case we must recommend you to a physician instead of
the home treatments.
GONORRHEA (Urethritis).--This can be called an infectious inflammation of
the urethra, caused by the gonococcus, a microbe or germ, causing a
specific inflammation of the mucous membrane of the urethra or vagina.
Incubation.--The time that elapses between the exposure and development of
the symptoms in the urethra is variable, extending from a few hours to
twelve or fourteen days. In the great majority of cases, however, the
disease appears during the first week. The patient notices a drop of
milk-like fluid at the opening of the urethra, which is slight, red and
puffed or turned out; a tickling sensation is often felt in this locality,
and the next time urine is passed it is attended with a feeling of warmth
at the end of the canal, or with actual scalding. After this the symptoms
increase rapidly in number and severity, so that within forty-eight hours,
or even sooner, the disease may be described as having passed its first or
increasing stage, the characteristic phenomena of which are as follows:
Changes in the meatus (opening). There are redness, eversion (turning
out), ulceration and eating away and often erosion of the lips of the
opening of urethra. Sometimes, but rarely, so much swelling that the
person can hardly pass the urine, which drops away. The other symptoms are
too well-known by those who have had this disease to need a description.
Prognosis.--It is now considered more than a cold, and it is the cause of
terrible sickness in both sexes, among the innocent as well as the guilty.
Treatment.--It may be cured perhaps in a short time, and yet no one can be
certain of its absolute cure. This disease is better understood now, and
the treatment is entirely different from formerly. The strong injections
are now considered not only useless but dangerous to the future health of
the patient. The best treatment is mild antiseptic injections, irrigation
carefully done by an expert person; remaining quietly in bed, being
careful to use food and drink that are not stimulating, keeping the bowels
open by proper diet and mild laxatives and the urine mild by soothing
diuretic remedies. Unfortunately those affected want quick work and they
get it, frequently to their future sorrow. The following are good
injections. Before each injection the urine should be passed and an
injection of an antiseptic like listerine, etc., one dram to an ounce of
boiled water, to cleanse the canal. You can use twice a day the following:
Fluid Extract Hydrastis (colored) 1 dram
Water 1 ounce
Use one dram of this for each injection. It stains the clothes so you must
be careful. This is good and healing.
[236 MOTHERS' REMEDIES]
GONORRHEAL ARTHITIS. (Gonorrheal Rheumatism, Inflammation of the
Joints).--This is more common in men than women. Occurring during, and at
the end of or after inflammation of the urethra. It usually involves many
joints, such as the temporal, maxillary and collar bone. The effusion in
the joints is usually serious.
Symptoms.--Variable joint pains may be the only one. The attack may
resemble an acute articular rheumatism of one joint, or a subacute
rheumatism of one or more.
Sometimes there is a chronic one-jointed inflammation usually of the knee.
The tendon sheaths and bursae may be involved alone, or with the joints.
Gonorrheal septicemia may result from arthritis. This is protracted.
Iritis is a most frequent complication. The urethra source of the
infection must be cured.
Treatment.--Keep the joint quiet and you can use an ice cap for the pain.
Tonic treatment with quinine, iron, and arsenic in chronic cases is
needed. The joints should be kept at rest in acute cases. In chronic cases
massage and slight motion. The tonics must be chosen for each individual
case. One afflicted with this must be under treatment for a long time.
HIP JOINT DISEASE. (Morbus Coxarius).--This is more common in children
than in adults.
Cause.--It is usually tubercular.
Symptoms. First stage.--It may be overlooked; slight lameness, a little
stiffness is noticed at times. The muscles begin to dwindle.
Second stage.--Child limps very perceptibly, dwindling is more apparent.
Pain appears.
Treatment.--Absolute rest. Lying down treatment if begun early arrests
this disease often. Build up the system. Splints and brace are needed
sometimes.
KNEE JOINT DISEASE. (White Swelling).--This is simply a tuberculous knee.
Treatment.--Rest. Stop motion of the joint by some form of splint or
plaster of Paris cast. Get a good physician at the beginning in these
cases and you will save lots of after worry and blame for yourself. It
does not pay to wait. These joint diseases will progress, and often
treatment is begun months after trouble is seated. It ought to be criminal
negligence and dealt with accordingly to neglect such diseases. Parents
should never forget that they have endowed their children with such a
constitution, and they should be glad and willing to correct it as far as
they can.
[INFECTIOUS DISEASES 237]
LEPROSY. Definition.--Leprosy is a chronic infectious disease, caused by
what is called the "Bacillus Leprae," and is characterized by the presence
of tubercular nodules in the skin and mucous membranes (tubercular
leprosy), or by changes in the nerves (anaesthetic leprosy). These forms
are separate at first, but ultimately they are combined and there are
disturbances of sensation in the characteristic tubercular form.
History.--Leprosy is supposed to have originated in the Orient, and to be
as old as the records of history. It appears to have prevailed in Egypt
even so far back as three or four thousand years before Christ. The Hebrew
writers make many references to it, and it is no doubt described in
Leviticus. The affection was also known both in India and China many
centuries before the Christian era. The old Greek and Roman physicians
were familiar with its manifestations, ancient Peruvian pottery represent
on their pieces deformities suggestive of this disease. The disease
prevailed extensively in Europe throughout the middle ages and the number
of leper asylums has been estimated at, at least, 20,000. Its prevalence
is now restricted in the lands where it still occurs while once it was
prominent in the list of scourges of the old world.
It is now found in Norway and to a less extent in Sweden, in Bulgaria,
Greece, Russia, Austro-Hungary and Italy, with much reduced percentage in
middle Europe; it is the rarest of diseases in England where once it
existed. In India, Java, and China, in Egypt, Algiers, and Southern
Africa, in Australia and in both North and South America, including
particularly Central America, Cuba, and the Antilles, it exists to a less
extent. It has been recognized in the United States chiefly in New
Orleans, San Francisco, (predominantly among the Chinese population of
that city). The disease has steadily decreased among the latter colonists
in Minnesota, Wisconsin and Iowa. Isolated cases have been recognized in
almost every state, and leprous cases are presented at the public
charities of New York, Philadelphia, Boston, etc. The estimated number of
lepers a few years ago in the United States varied between two hundred and
five hundred. It is represented as diminishing in frequency in the
Hawaiian Islands, Porto Rico and the Philippines. In the Hawaiian Islands
it spread rapidly after 1860, and strenuous attempts have been made to
stamp it out by segregating all lepers on the island of Molokai. There
were 1,152 lepers in that settlement in 1894. In British India, according
to the leprosy commission, there were 100,000 lepers in 1900.
Cause.--The bacillus, discovered by Hansen, of Bergen, in 1874, is
universally recognized as the cause of leprosy. It has many points of
resemblance to the tubercle bacillus. These bacilli have been found in the
dwellings and clothing of lepers as well as in the dust of apartments
occupied by the victims.
[238 MOTHERS' REMEDIES]
The usual vehicle by which the disease is transmitted is the secretions of
a leprous patient containing bacilli or spores. The question of
inheritance of leprosy is regarded now as standing in the same position as
that relating to the inheritance of tuberculosis; no foetus, no new-born
living child, has been known to exhibit the symptoms of either disease.
Several cases have been cited where infants but a few weeks old exhibited
symptoms of leprosy. It affects men more than women. Infection is more
common after the second decade, though children are occasionally among its
victims. When it occurs in countries where it had not previously existed,
its appearance is invariably due to the infection of sound individuals by
lepers first exhibiting symptoms where the disease is prevalent.
Neisser states this: "The number of lepers in any country bears an inverse
ratio to the laws executed for the care and isolation of infected persons.
The disease appears to spread more rapidly in damp and cold, or warm and
moist, climates than in temperate countries. It is not now regarded as
contagious. The leprosy of the book of Leviticus not only includes lepra,
as that term is understood today, but also psoriasis, scabies and other
skin affections," The leper, in the eye of the Mosaic law, was
ceremoniously unclean, and capable of communicating a ceremonial
uncleanness. Several of the narratives contained in the Bible bear witness
to the fact that the Oriental leper was seen occasionally doing service in
the courts of kings, and even in personal communication and contact with
officers of high rank.
Symptoms.--Previous symptoms: Want of appetite, headache, chills,
alternating with mild or severe feverish attacks, depression, nosebleed,
stomach and bowel disturbances, sleeplessness. The durations of these
symptoms is variable. Some patients will remember that these symptoms
preceded for years the earliest outbreak of lepra (leprosy). In other
cases only a few weeks elapsed. These earlier skin lesions are tubercular,
macular (patches), or bullous elevations of the horny layer of the skin.
It may then be divided into three varieties tuberculous, macular and
anaesthetic.
LEPRA TUBEROSA. (Tuberculated, Nodulated or Tegumentary (skin) Leprosy).--
This nodular type comprises from ten to fifty per cent of cases. After the
occurring of the symptoms just mentioned spotted lesions appear, which are
bean to tomato in size, reddish brown or bronze-hued patches, roundish,
oval or irregular in contour, well defined, and they occur upon the face,
trunk and extremities. The skin covering them is either smooth and
shining, as if oiled, or is infiltrated, nodulated and elevated. The
surface of the reddened spots is often oversensitive.
[INFECTIOUS DISEASES 239]
After a period ranging from weeks to years, tubercles rise from the spots
described, varying in size from a pea to that of a nut, and they may be as
large as a tomato. They are in color, yellowish, reddish-brown, or
bronzed, often shining as if varnished or oiled, are covered with a soft,
natural, or slightly scaling outer skin, roundish or irregular in shape
and are isolated or grouped numbers of very small and ill-determined
nodules may often be seen by careful examination of the skin in the
vicinity of those that are developed. They may run together and cause
broad infiltrations and from this surface new nodules spring. They may be
in the skin or under the skin and feel soft or firm. The eruption of these
tubercles is usually preceded at the onset by fever, as well as by puffy
swelling of the involved region, eyelids, ears, etc. These leprous
tubercles choose the face as their favored site. They mass here in great
numbers, and thus produce the characteristic deformity of the countenance
that has given to the disease one of its names, Leontiasis (lion face).
In such faces the tubercles arrange themselves in parallel series above
the brows down to the nose, over the cheeks, lips and chin, and as a
result of the infiltration and development of the conditions the brows
deeply over-hang; the globes of the eyes, and the ears, are so studded
with tubercular masses as to stand out from the side of the head. The
trunk and extremities, including the palms of the hands and soles of the
feet, are then usually involved to a less degree. The arm-pit, genital and
mammary regions, and more rarely the neck and the palms of the hands and
soles of the feet, may be invaded. In occasional cases when the
development of tubercles upon the face and ears is extensive, there may
not be more than from five to fifty upon the rest of the body, and these
either widely scattered and isolated or agglomerated in a single hard,
flat, elevated plaque of infiltration upon the elbow or thigh. When the
tubercles run together (become confluent) large plaques of infiltration
may form, which are elevated and brownish or blackish in color.
The soft palate and larynx are often involved when the skin lesions are
present. The voice may sound gruff and hoarse, and the tongue, the larynx
and soft palate have been found studded with small sized, ashen-hued
tubercles. These tumors or tubercles may degenerate and form into
irregularly outlined, sharply cut, glazed ulcers, with a bloody or
sloughing floor, or they may disappear and leave behind pigmented,
shrunken depressions, or they lose their shapes from partial resorption. A
large plaque may flatten in the center until an annular disk is left to
show its former location. Coincident symptoms are disturbance in the
functions of the sweat and sebaceous secretion, thinning and loss of hair
in the regions involved, especially the eyebrows, and disorders of
sensibility. Later results, are a nasal catarrh, atrophy of the sexual
organs in both sexes, with impairment or loss of procreative power,
hopeless blindness. However the course of the disease is very slow, and
years may elapse before these several changes are accomplished. Often the
disease appears quiescent for months at a time, after which fever occurs
and with it acute or sub-acute manifestations appear, including gland
disease, orchitis, ulcerative processes, slow or rapid, followed by
gangrene and a relatively rapid progress is made toward a fatal
conclusion.
Toward the last the mutilations effected by the disease may result. Parts
of the fingers or toes, whole fingers or toes, and entire hand or foot may
become wholly or partially detached by the ulcerative and other
degenerations. This stage of this type of the disease may extend through
ten or more years. After it has fully developed the dejected countenance
of the leper, with his leonine expression and general appearance is highly
characteristic.
[240 MOTHERS' REMEDIES]
LEPRA MACULOSA.--This form is more common in tropical countries and is
distinguished chiefly by its macular (spotty) lesions. In size they vary
from a small coin to areas as large as a platter. They are diffused or
circumscribed, roundish or shaped irregularly, yellowish, brownish or
bronzed in color, often shiny or glazed. They may be infiltrated and may
be elevated, or on a level with the adjacent tissues. The patches are
usually at first very sensitive, but they finally become insensitive, so
that a knife can be thrust deeply into them without being felt. The
regions chiefly affected by this type are the back, exposed parts, the
backs of the hands and wrists, the forehead, the cheeks, ears, back of the
feet, and ankles. The eruptions may be scanty or general; conspicuous or
insignificant. The eruptive symptoms are associated commonly, early or
late, with the serious phenomena described below.
LEPRA ANAESTHETICA. (Nerve Leprosy. Atrophic Leprosy. Lepra
Trophoneurotica).--Before the development of this form of leprosy there
may be one or two years of ill-health. Usually the skin at this time
becomes in localized patches over-sensitive, sometimes there is
over-sensitiveness and special nerves, because of their enlargement,
become accessible to the touch. Those named later become tender, and the
seat of lancinating or shooting pains. This clinical variety may be
commingled in its symptoms with each of the other types. With or without
such commingling, however, there commonly is noted, after exposure to cold
or after being subject to chills first an eruption, red (erythematous)
patches, or of "bullae," size of a bean on cheeks, ears, back of the feet,
and ankles. The eruption may be outer skin covering (epidermis) and filled
with a clear tinted or blood-mixed serum, and usually occurring upon the
extremities. The scars that follow are shrunken (atrophic) patches, each
often greater in extent than the base of the original trouble, color
whitish, shiny, glazed, or better described as a tint suggesting the hue
of mica; their outline is circular and form also the dumb-bell figure by
running (coalescing) together, or juxtaposition. These scars are always
without sensitiveness (anaesthetic), and they may exist together with
spotted and non-sensitive patches upon the trunk or other parts such as
the face, hands, feet, ankles, thighs, but rarely on the palms and soles.
Neither those of the one class nor of the other, however, are disposed
over the surface of the body in lines, bands or curves, corresponding with
the distribution of the skin (cutaneous) nerves. Sometimes the ulnar and
other nerves (median, posterior tibial, peroneal, facial and radial) that
are accessible to the touch are swollen, tender, insensitive or as rigid
as hardened cords. Reddish-gray swellings may be recognized by the eye
along the nerve tract. General shrinking skin symptoms follow. The skin
becomes dry and harsh; there is little or no sebaceous product and the
skin of the face seems tightly drawn over the bones. As a consequence of
deforming shrinking (atrophy) of the eyelids, a persistent overflow of
tears, consequent eye changes follow, and a constant flow of saliva
escapes from the parted lips. The fingers are half drawn into the palm of
the hands; the nails are distorted and ulceration occurs later. These
ulcers are irregular, oval, roundish or linear in form covered with thin
blackish, flattened, tenacious crusts with soft bases, and their floors
covered with a soft debris mixed with blood, the whole insensitive to
every foreign body, and external application. At last the symptoms of
mutilating lepra (leprosy) may occur, digits or portions of the wrist,
part of hand (meta carpus) or corresponding portions of the foot may be
detached from the body. Death may occur at any time during the course of
the disease. In this form it is said to last from eighteen to twenty years
and is thus not so rapidly fatal as the tubercular variety.
[INFECTIOUS DISEASES 241]
Treatment.--The main treatment is the isolation and segregation of all
lepers from contact with the well; wholesome laws are enforced in some
countries where leprosy prevails, and provision is made not only for the
isolation and segregation, but also for their care. On account of its
relative variety America has not yet awakened and legislation only forbids
the entry of infected persons. At Molokai, in the Hawaiian Islands,
provision is made for the care of lepers. Many of the public hospitals for
the care of the sick poor refuse to receive lepers. The child of a leprous
woman should be removed from the mother after birth and not nursed by
another woman. No medicines are known to have any curative effect. An
immediate change of residence and climate should be made if the patient
happens to live in a district where the disease prevails. A highly
nutritious diet should be taken.
The outlook.--The future is in general dark for the leper. It is often of
a malignant character, and a fatal result is the rule. A change of climate
and conditions may help. Scandinavian lepers who have removed to the
United States have been greatly benefited by the change, but there is no
known cure. The isolation should be as effective as that for tuberculosis.
It is not contagious but infectious.
HYDROPHOBIA.--Rabies and hydrophobia are two different terms, meaning the
same disease, the former meaning to rage or become mad. This term applies
more especially to the disease as it exists in the maniacal form in the
lower animals, while hydrophobia comes from the Greek, meaning "dread of
water." As we occasionally find this dread of water only in the human
subject, the term is properly used in such a case. The lower animals
frequently attempt to drink water even though the act brings on a
spasmodic contraction of the swallowing (deglutitory) muscles. Hydrophobia
is an acute infectious disease communicated to man by the bite of an
animal suffering from rabies. It is due to a definite specific virus which
is transmitted through the saliva by the bite of a rabid animal. Its
natural habitat (location) is the nervous system, and it does not retain
its virulence when introduced into any other system of organs. It is
essentially a nervous disease and transmitted by the saliva of rabid
animals. When inoculated into a wound this virus must come in contact with
a broken nerve trunk in order to survive and reproduce itself. If by
accident it attacks the end of the broken nerve trunk, it slowly and
gradually extends to the higher nerve centers and eventually produces the
disease.
[242 MOTHERS' REMEDIES]
The incubation, or the time it takes for the disease to develop, varies,
but usually is from three to six months. There is a recorded case where
the person began to show symptoms of the disease thirteen days after
having received a severe wound on the head. The incubation period is
seldom longer than six months. The symptoms of the disease in the human
being vary within narrow limits. There are three classic symptoms usually
encountered, and these are fear, apprehension or excitement, together with
deglutitory (swallowing) spasms, terminating in general paralysis. The
patient remains conscious of his agony to the end, but the period of
illness is of short duration, lasting from one to three days.
The bites of rabid dogs cause ninety per cent of the cases in man and
animals. The cat is the next important factor in spreading the disease and
about six per cent of the cases are caused by this animal. For other cases
four per cent come from bites of horses, wolves, foxes, etc. The wolf in
Russia, or other animals like it, may be the chief cause there; but dogs
cause ninety per cent, taking all the cases found. Man, dog, cat, horse,
cattle, sheep, goat, hog, deer, etc., are subject to the disease either
naturally or experimentally. The disease is confined commonly to dogs,
because the dog naturally attacks animals of his own species and thus
keeps the disease limited mainly to his own kind. Naturally the dog
follows this rule, but on the other hand, in the latter stages of the
disease he usually goes to the other extreme and even attacks his own
master, etc. The dogs that are the most dangerous and do the greatest
damage are of the vicious breeds.
The rabbit or guinea pig is used for demonstration in the laboratory.
Guinea pigs respond to the virus more rapidly than do other animals and
therefore they are especially useful in diagnostic work. Rabbits, however,
on account of the convenient size and ease with which they are operated
upon, are usually the choice in the production of material used in
treating patients.
The director of one Pasteur Institute says, "We have two classes of
patients to deal with in the Pasteur institute. The larger class, of
course, are those inoculated by the bite of rabid animals, but we also
have a few who are infected by the rabid saliva accidentally coming in
contact with wounds already produced. In these accidental eases the
disease is almost as likely to result as in those to whom the virus is
directly communicated by the bite." The wounds considered most dangerous
are the recent fresh wounds. The possibility of infection decreases with
the formation of the new connective tissue which protects the ends of the
broken nerve fibres. One must remember, however, that wounds over joints,
especially on the hands, are likely to remain open for some time. A dog
ill of this disease can give the disease to man through licking a wound.
Such a case has been recorded. This dog licked the child's hands before it
was known to be mad. The child died from the disease. As stated before
ninety per cent of the cases are inoculated by the bites of rabid animals.
[INFECTIOUS DISEASES 243]
The wounds are considered according to their severity and location.
Lacerating, tearing wounds upon uncovered surfaces, especially the head,
are the most dangerous. This is due to the fact of the closeness of the
brain and the large amount of infection in such a wound, and for this
reason treatment should be immediately given. But smaller wounds should
also be treated for the smallness of the wound furnishes no sure criterion
as to the future outcome of the disease. All possible infections should be
regarded as dangerous when considering the advisability of taking the
Pasteur Treatment. The small wound has usually a longer period of
incubation, because of the small amount of infection, still it may cause a
fatal termination. A dog never develops rabies from a lack of water or
from being confined or overheated during the summer months. A spontaneous
case of rabies has never been known. It must be transmitted from animal to
animal and the history of the case will point to a previous infection by a
diseased animal.
Where rigid quarantine rules exist the disease does not occur. In
Australia they quarantine every dog, that comes to that country, for six
months, and in consequence they have never had a case of rabies. In Russia
they have had many cases. In Constantinople the disease frequently "runs
riot." France has lost as many as 2,500 dogs in one year. Before the
Pasteur Treatment was instituted (in 1885) there was an average of sixty
deaths in human beings in the Paris hospitals.
Belgium and Austria average one thousand dogs annually. There was a yearly
average in Germany of four hundred dogs, dying of rabies, until the law
requiring the muzzling of dogs was strictly enforced and since that time
the disease is practically unknown. We do not have strict quarantine laws
against dogs, and the result is death from hydrophobia in many states
annually. It was formerly believed that rabies was a hot weather disease.
The number of cases during the winter months of late years has disproved
that belief, for the records of the institute for treatment of hydrophobia
at Ann Arbor have shown a decrease of cases during the summer months. This
was before 1908. This shows that rabies is not a hot weather disease.
[244 MOTHERS' REMEDIES ]
Ordinarily cases of rabies occur here and there (sporadic), but if the
conditions are favorable epidemics break out. One dog may bite several
dogs and these dogs bite others and thus spread the disease to many. Not
every animal bitten by a mad dog develops the disease. The disease does
not always follow the bite. Only about forty per cent of all animals
bitten by a mad dog contract the disease. This is given by a noted
authority. Statistics also show that in man the disease develops in only
about twenty per cent of the cases in those who have been bitten by rabid
dogs. But in dealing with those who have been bitten such measures should
be taken as would be if they were certain of developing the disease; one
cannot tell how much poison enters the system in such cases and preventive
procedures should be taken. There are reasons why everyone who is bitten
does not contract the disease.
The location and character of the bite must be considered. Bites on the
head, neck and hands have been recognized as more dangerous, from early
times, and such bites produce fatal results quicker than do bites on other
parts of the body, and the reason is largely due to the fact that the
other parts of the body are more or less protected by the clothing, and
this clothing prevents the entrance of so much poison into the system.
Bites on the head give a high mortality rate and are rapidly fatal. The
close proximity to the brain is one reason.
The part the clothing plays in protection is clearly shown by the
following quotation from an eminent authority: "In India where the natives
dress very scantily, the mortality was exceedingly high up to a few years
ago, at which time the British introduced the Pasteur laboratories. The
clothing protects the body and it holds back the saliva and can be looked
upon as a means of filtering the saliva of the rabid animal, most of the
saliva is held back as the teeth pierce the clothing, so that upon
entering the flesh the teeth are practically dry, and only a portion of
the virus is introduced. Upon entering the wound this small amount of
virus is further diluted by the tissue juices to the non-infectious point.
We know from actual experimental work in the laboratory that the higher
dilution will not kill."
If a portion of the brain of an animal dead from street virus is taken and
made up in a dilution of one to five hundred, and this is injected, we
find that it does not produce death. But a dilution of one to three
hundred will invariably kill. This is practically what very often happens
when one is bitten through the clothing. The saliva may be filtered and
held back so that a small amount is introduced; perhaps a dilution of one
to five hundred of the virus may get into the wound, but this is usually
not enough to cause the disease. There is no possible way of estimating
the amount of the inoculation. In such cases one's chances of never
contracting the disease are only decreased; that is all we can say.
The treating of individuals, bitten by rabid animals, in the Pasteur
Institutes, is simply the practical application of results obtained by
Pasteur from his original work on rabies virus. Pasteur was a French
chemist living in Paris, and he began his search for the cause and cure of
rabies in 1880. He hoped to find a sure method of preventing the
development of the dread disease, even if he could not find a cure for it
after it had developed. While he was pursuing this research Pasteur had
access to the cases of rabies in the Paris hospitals, and these numbered
sixty each year. He had practically an unlimited supply, for France could
furnish him with twenty-five hundred more mad dogs, and a large number of
other animals each year.
[INFECTIOUS DISEASES 245]
Pasteur devoted the remainder of his life to the study of this subject. He
collected some saliva from the mouth of a child, on December 11, 1880, who
had died at the Hospital Trousseau four hours before. This saliva he
diluted with distilled water, and this mixture he injected into rabbits,
and they all died, and the saliva taken from these rabbits when injected
into other rabbits caused their death with rabies. He found also that
saliva from rabid dogs almost always caused the disease. The incubation
period varied within wide limits, and very often the animals lived. He
then used the blood of rabid dogs for inoculation, but these blood
inoculations always failed to produce the disease. Pasteur was convinced
after careful study of rabid animals during the many months necessary to
complete his experiments, that rabies was a disease of the nervous system,
and that the poison (virus) was transmitted from the wound to the brain by
the way of the nerve trunks. Then to prove his theory Pasteur removed a
portion of the brain of a dog that had died of rabies. A part of this was
rubbed up in sterile water and used to inoculate other animals; and
subcutaneous inoculations with this material almost always produced death.
After this Pasteur tried a new method and injected directly into the
nervous system, either into the nerve trunk or directly into the brain,
after trephining, and all such injections produced rabies in the injected
animal and death. He also found that rabbits inoculated in the brain
always died in the same length of time. When he injected into the nerve
trunk the inoculation period was longer, depending upon the distance from
the brain. Two problems now remained for Pasteur to solve, and these were,
how could he obtain the definite virulence and how could he reduce the
virulence regularly and gradually, so that it could be used by inoculation
safely as a vaccine to produce immunity to rabies in healthy animals, and
also to prevent the development of rabies in animals bitten by rabid
animals. He first tried successive inoculations. These inoculations were
made, after trephining, directly to the brain, and he used a portion of
the brain as a virus each time. He inoculated rabbit number one with a
portion of brain taken from a rabid dog, and this rabbit died on the
fifteenth day. He then inoculated rabbit number two with a portion of the
brain of rabbit number one; from the brain of rabbit number two the virus
was supplied for inoculating rabbit number three, and thus the brain of
each inoculated rabbit was taken, after its death, for material to
inoculate the next rabbit in the series. This experimentation showed him
that each rabbit in the series died a little sooner, showing that the
virus was becoming more virulent, till no increase in activity of the
poison was shown after the fiftieth successive inoculation. "Rabbits
inoculated with a brain suspension of rabbit number fifty all died in
seven days." This caused Pasteur to name the virus of number fifty "virus
fixe," a virus of definite length. He now had obtained a virus of definite
strength and the next question was, how could the virulence be gradually
and definitely reduced.
[246 MOTHERS' REMEDIES]
This he accomplished after many experiments. He proved that pieces of the
"medulla oblongata" suspended in sterile tubes which contained fragments
of caustic potash, steadily and gradually reduced their virulence as they
dried, till the fourteenth day, when they were practically inert. New
specimens were prepared each day and cords which had dried in one day
Pasteur called "one-day virus;" cords which had dried in two days, "two
day's virus," and so on up to the fourteenth day. With this graduated
virus he now experimented on dogs, and the injection he used on the first
day consisted of an emulsion of fourteen-day virus; for the second day,
the thirteen-day virus, thus using a stronger virus each day, until on the
fourteenth day he used the full strength virus. This treatment produced
what is called immunity in the dog, and even the direct inoculation into
the brain of the strong virus would not produce death.
After Pasteur had thoroughly satisfied himself by repeated trials, he
announced his wonderful discovery, and it was in 1886 that Pasteur
considered the preventive inoculation in human beings as resting upon a
satisfactory experimental basis. During these five years this eminent man
proved that it was possible to protect or immunize the lower animals,
rabbits and dogs, against inoculation with the virulent virus.
The efficiency of this immunity was given trials by different methods of
inoculation. It was found that sixty per cent of dogs inoculated under the
"dura" (a membrane of the brain) were saved if treatment was given the
second day. This test is more severe than is required to meet the ordinary
infection of rabies. Pasteur, after a series of these final tests were so
convincing, prescribed the preventive inoculations in human beings and on
July 6th, 1886, the first human patient received the first treatment of
his series of inoculations.
The method of obtaining the attenuated virus used in the treatment is as
follows: A rabbit is inoculated by the brain method before described, each
day, with suspension of the fresh, fixed virus. These rabbits die in six
days after the inoculation. In this way a rabbit dies each day; the spinal
cord is removed, divided into sections, and suspended in a flask
containing potassium hydrate. The action of potassium hydrate is drying
(desiccating). A series of these cords, which have been hung on fourteen
successive days, are always kept in stock for the treatment of patients.
The virus becomes less active with each successive day of exposure to
drying (desiccation) and finally the virulence is altogether lost.
When the patient comes for treatment the fourteenth and thirteenth-day
cords are used for the first inoculation, and on each successive day the
patient receives inoculation, the strength of which has been regulated by
the number of days the cord has been hanging. During the first four days
patients receive injections of six cubic centimeters of emulsions made
from cords aging from fourteen to seven days, and from the fifth day until
the completion of the course of treatment patients receive emulsions from
cords of higher immunizing properties, but no cords desiccated for less
than four days are used.
[INFECTIOUS DISEASES 247]
Death rate from 1878-1883 before Pasteur treatment was instituted taken
from documents in the department of the Seine:
1878 143 bitten. 24 deaths.
1879 76 " 12 "
1880 68 " 5 "
1881 156 " 22 "
1882 67 " 11 "
1883 45 " 6 "
Average of one death to every six bitten, or seventeen per cent mortality.
Incubation period from eleven days to thirteen months, average one hundred
and twenty days, depending upon location of bite. Pasteur Institute
records during the years 1886-1887 and first half of 1888, show that
Pasteur had under his supervision 5,374 persons bitten by animals either
proven or thought to have been mad. Mortality for 1886 was 1-34 per cent,
during 1887 it was 1-12 per cent, during 1888 it was 77/100 per cent. With
the later treatment the mortality has decreased to 3-10 per cent in 1908.
The Pasteur method of treatment is a process of immunization which must be
completed before the development of the disease. It is of no value after
the symptoms have appeared.
Those who have not been affected can be immunized the same as those who
have been bitten. The individual who has been bitten by a mad dog realizes
when and how severely he has been bitten, and were it not for the
so-called period of latent development of the virus, it would not be
possible to carry out the Pasteur treatment. The patient may, if he will,
take advantage of this fact and be immunized by treatment before the
disease has developed. Deep and severe bites are most dangerous, but the
disease may develop simply from a rabid dog licking a scratch of the skin.
As before stated bites on exposed or uncovered surfaces, are more
dangerous than those through clothing. There is a very easy access of the
saliva to the wound in the unprotected part, while in the protected parts
the teeth in passing through the protection, clothing, are freed of their
saliva at least partially. The virus is conveyed from the bitten part or
inoculation to the central nervous system through the nerve trunk, and the
rapidity of extension depends upon the resistant powers of the patient,
the virulence and the amount of virus deposited in the bitten part at the
time the person was bitten. This disease develops only in nerve tissues.
Virus can be found in the nerves of the side bitten, while the
corresponding nerves on the opposite side are free from it. It can be
ascertained that the virus is present in the medulla oblongata before the
lower portion of the cord.
[248 MOTHERS' REMEDIES]
Comparative danger.--A wound of the hand after a delay of three weeks is
as dangerous as a bite on the head exposed only a few days. There is
always a possibility of an accumulative action and extension of the virus
along the nerve trunk to the central nervous system during the interval of
exposure, and this should be always borne in mind. It is stated by
authority that the virus is not transmitted by the bite of a rabid animal
until two days previous to the appearance of the first symptoms. It is
with some difficulty that a decision is reached in advising patients who
are bitten to take treatment early in the course of the disease. The
symptoms are often so very obscure and slight that they are not
recognized. If a dog which is not naturally vicious suddenly bites without
any cause it should be tied securely and watched for seven days; and
should it develop symptoms of the disease during this period the bite
should be considered dangerous.
Immediate treatment of the wound.--A temporary measure is the
cauterization of the wound; do not neglect this because a few hours have
passed since the person was bitten, for wounds may be cauterized with
advantage even after two or three days have elapsed. Of course the earlier
it is done the better. If they are thoroughly laid open and scrubbed it is
more effective. Nitric acid used freely is the best method to use. Wash
the wound freely with boiled water after the acid has been applied;
ninety-five per cent carbolic acid may be used if nitric acid cannot be
obtained.
If carbolic acid is used it is necessary that it be washed from the wound
by the free use of absolute alcohol, followed by boiled water and a
dressing of bichloride of 1-7000. This prevents the ulceration of the
wound by the carbolic acid. Cauterization thoroughly done destroys a part
of the inoculated virus. Thorough cauterization is especially necessary
with large wounds in which large quantities of the virus is inoculated.
When to send patients to an Institute.--Send them immediately, if there is
good reason to believe the animal had rabies. It is not wise to wait until
the animal dies; it is very important that treatment is begun as soon as
possible, especially in severe bites.
What to send for examination.--The entire head may be sent by express, or
better, the health officer should bring it in person. This saves time and
relieves anxiety; or a portion of the brain may be removed under
thoroughly clean conditions and placed in a sterilized twenty per cent
solution of glycerin and water. In this way the virus retains its
virulence and putrefaction is diminished. The first method is the best,
taking the head directly. The head after it reaches the laboratory is
examined microscopically for "negri bodies," and if there is no
contamination the microscopic findings are verified by animal
inoculations. The presence of negri bodies in a specimen is of great value
owing to the rapidity with which a diagnosis can be made. In one case a
positive diagnosis was reported within twenty minutes after the specimen
entered the laboratory and within the next hour and a half the patient
bitten by the dog the same day had begun her course of protective
injections and was saved.
[BLOOD AND DUCTLESS GLANDS 249]
Protection.--To stamp out this disease city authorities, etc., can enact
laws. All ownerless dogs should be killed, and the keeping of useless dogs
should be discouraged by taxation. All dogs should be thoroughly muzzled
where the disease prevails. This article is made up from an article
written by an acknowledged authority on this disease, a man in charge of a
Pasteur Institute.
Cities where Pasteur Institutes are located:
Ann Arbor, Michigan. Baltimore, Maryland.
Chicago, Illinois. Austin, Texas.
Minnesota. Toronto, Ont.
New York City.